Are Restylane injections or fat grafting injections better for filling temporal hollows?

I have very hollow temples (after a cranitoomy to remove a benign tumor) and want to know iif corrections with injecction of Restylne has major complication risks concerning vascular occlusions that is less risky than longer lasting fat injections?

Doctor Answers 7

What should I use for my temporal hollows?

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Hi Racheal, both fat and Restylane are great options to fill in the temporal hollows. Restylane is a less invasive option with limited longevity, requiring repeat injections roughly every six to nine months. 

Fat is a great option that has the potential to last for several years however it is more difficult to predict how much of the fat will survive and injecting the fat is a bit more invasive. That being said, it is still very reasonable to be able to perform a fat transfer procedure in the office.

Newport Beach Facial Plastic Surgeon

Fat or Filler for temporal hollowing

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Dear racheal7:

I hope you are well following your craniotomy!

Fillers injections are the way to go for temporal hollowing. As you have inquired, Restylane and Fat are 2 of several fillers I use for this problem. Each comes with its advantages and disadvantages.

Fat is a wonderful biologic replacement for atrophic areas to be filled. It must revascularize in order to survive but the temples provide a very good environment for this to occur. That said, anticipate 50-70% of the fat injected may resorb. Due to the small volumes you will need on several sessions, this may be done under local anesthesia with or without oral or IV sedation. 

Injectable fillers include temporary and more permanent, inert or bio-stimulatory molecules. 
Restylane is part of a family of temporary fillers called Hyaluronic Acid (HA) gels. Each HA is created with the same molecule but of different lengths and with more or less links. These attributes add to longevity and hydrophilia (water attraction) and projection. 

Another filler I might recommend to consider with the evaluation of a talented and skilled, Board Certified Plastic Surgeon or ENT Facial Surgeon is Sculptra. This not so well known bio-stimulatory filler may be used alone or with HA's. Sculptra initiates the body's own response to firm and fill with structural molecules such as hyaluronic acid, elastin and others. It works very well in the temporal hollows but there is a 3 month lag period and the need for multiple sessions. 

All fillers including fat have the concern of intravascular injection and vessel occlusion. This is a risk to discuss with your injector(s). 

Depending on the amount of hollowing or deformity, implant surgery may be available as well. 

I hope this has been helpful! I wish you the best!

Dean P. Kane, MD, FACS
Baltimore Plastic Surgeon
4.9 out of 5 stars 103 reviews

Temporal Hollowing

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Hello Racheal7,

Both are options for temporal wasting.  Fat grafting is more invasive involving the harvesting and would likely require a trip to the operating room.  Restylane can be injected in the office.  They both carry similar risks as far as vascular occlusion.  In theory fat grafting have the ability to last longer although their durability is frequently questioned.  You may also consider Sculptra as it helps to form new collagen in the area with longer last improvement compared to other fillers.

In order to determine what is best for you I'd recommend you consult with a facial plastic surgeon or plastic surgeon.  This way you can find out about the surgical option (fat grafting) and the filler option from someone who can offer both.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Temporal hollows

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I have used both.  Often the temporal hollows I fill with fat during a facelift.  But either one can give nice results.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Filling Temporal Hollows

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Please keep in mind that fillers such as Restylane or Juvederm which are made of hyaluronic acid can be dissolved if needed in the event of a problem.  Fillers such as fat cannot be dissolved and therefore can be more problematic if there is some kind of problem.  Vascular occlusion is rare but can occur with any filler.  It is very important for you to see an experienced, conservative injector.  

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 28 reviews

Temporal Hollows

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Thank you for posting your question.  Be careful asking which is better - you should be asking which is better for your particular case.  The choice of filler that is used versus fat grafting will depend on the experience of your surgeon and what they feel is best for you.  I'm sure that you will get many opinions on the topic.  The only way to get a legitimate recommendation is to schedule a consultation with a board certified physician who feels comfortable with both of those techniques.  Good luck!

Samuel Baharestani, MD
Long Island Oculoplastic Surgeon
4.9 out of 5 stars 38 reviews

Hollows in the Face and Fillers

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Voluma, Restylane, Juvederm, Sculptra would all work well to fill this hollow. Since this is an advanced technique be certain to consult with a board certified dermatologist who is an expert with these facial injections.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.